Methotrexate, another abortion-inducing medication, is used to treat ectopic pregnancies as well as rheumatic illnesses, inflammatory bowel disease, psoriasis and cancer. A recent study also reported 28 women with dangerous pregnancies at two Texas hospitals faced delays for care because fetal cardiac activity was detected, according to the AP. As the Supreme Court appears poised to return abortion regulation to the states, recent experience in Texas illustrates that medical care for miscarriages and dangerous ectopic pregnancies would also be threatened if restrictions become more widespread. The other miscarriage treatment is a procedure described as surgical uterine evacuation to remove the pregnancy tissue the same approach as for an abortion. Down in the kitchen, images from recent scans and ultrasounds were stuck to the fridge. If the lawsuit is successful, plaintiffs can receive up to $10,000. The American College of Cardiology and the American Heart Association, for example, advise women with certain congenital heart conditions to avoid pregnancy altogether, as they are at higher risk of illness or death shortly after giving birth. But pregnancy care isnt as clear cut as the law makes it out to be, doctors say, and fear of criminal prosecution has led medical professionals to delay or deny care they otherwise would have provided. For doctors treating such patients, the Texas law creates quite a conundrum, Dr. Snyder said. Her doctor said she had been calling other hospitals, but none of them would help. In 2012, a woman died in Ireland after her waters broke at 17 weeks and doctors refused to give her an abortion. You dont get a lot of time to respond, and if you dont respond quickly enough, your patient expires.. She had the proof. Its our 10th year participating in Amplify, and to celebrate, weve got $15,000 in matching funds from four generous Tribune supporters. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Cheng, in San Antonio, said that even as she cautiously points her patients to their options out-of-state, shes well aware that many of them struggle to even make it to their appointments in-state. It is just possible that chemical abortions more than half of all U.S. abortions soon could be outlawed nationwide. Many physicians disagree, pointing out that the law can disrupt care for pregnant women who have underlying health problems that are not immediately life-threatening, such as pulmonary hypertension or certain types of cancer. In Texas' anti-abortion . Yet under the new law, Dr. Thoppil felt he could not counsel her on terminating the pregnancy. Other times patients don't report the problem and miscarry on their own, she said, but without medication they risk additional bleeding. (1) the immediate abortion of her pregnancy without the delay necessary to determine the probable post-fertilization age of the unborn child; (2) the abortion of her pregnancy even though the post-fertilization age of the unborn child is 20 or more weeks; or (3) the use of a method of abortion other than a method described by Section 171.045(b). But Prager believes that the laws in Texas and perhaps elsewhere soon . However, if the ectopic pregnancy is located in the cervix or on the scar tissue from a cesarean section, the treatment could be the same as an abortion, according to Addante. Dr. John Thoppil, an obstetrician in Austin, doesnt perform abortions, providing prenatal care and delivering babies. The facts were grim. The new law in Texas bans abortion at 6 weeks when a fetal "heartbeat" can be detected. A previous version of this story incorrectly reported the name and location of a clinic. Nitsch says she chose sterilization at age 36 rather than risk getting pregnant by another rapist. "And yet we're being pulled through this.". I couldn't give you life. They had to call their OB/GYN repeatedly to get the $500 delivery deposit refunded. For some, that's too difficult, given the emotions surrounding the pregnancy loss, she said. Those can be acute life-threatening emergencies, she said. It also sets out civil, criminal, and professional penalties for abortion providers who violate the law. Because at this point, I'm in survival mode. "They can absolutely do that.". But it was the only choice they had to save this young woman. She eventually agreed, and the treatment was begun as soon as an abortion was performed. I knew something was wrong.. It is life-threatening to the mother and is not viable and needs to be removed. Hall managed not to scream any of this at the protesters, instead just silently flipping them off. Elizabeth knows it was just a terrible coincidence, an awful bureaucratic oversight, and yet it drove home to her how powerless she was, how alone, in that vast medical system of rules, legal regulations and revenue. "And that may mean in certain circumstances protecting the mother in this situation and the child passing away.". After Hall made it through the protesters and the clinics security screening, the clinic itself was an oasis, she said. Julie Ann Nitsch, a sexual assault survivor and community college trustee in Austin, Texas, is among many women in states with restrictive abortion laws who are taking drastic steps. And that's a big part of this problem, when we as physicians are trying to relieve patients' suffering. So we look at them like a ticking time bomb and wait for the complications to develop, Dr. Palmer said of her patients. Her discharge had to be darker. Dr. Ingrid Skop, a San Antonio obstetrician and member of the American Association of Pro-Life Obstetricians and Gynecologists, during a House Oversight Committee hearing in September. Crawford, the OB/GYN and fertility clinic co-founder, said shes seen instances of pharmacies not wanting to fill prescriptions for certain medications that are related to abortions but being used for other treatments. It was because of the state law which forbids termination of a pregnancy as long as there is fetal cardiac activity. Whether an ectopic pregnancy is legal will depend on individual state laws. In Texas, a 2021 law made it easier to sue anyone who helps a person get an abortion after about six weeks of pregnancy. Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law. "And yet we were. Lauren Hall, 27, fought the urge to scream back and tell them just how badly she wished life was a choice she could have made. I would consider what I experienced that weekend a medical emergency.. Because the state has made it very clear that if you talk about this, you're vulnerable to being sued," she added. The Texas law, which is also called Senate Bill 8, carves out an exception for termination in a medical emergency, which is defined in the states health code as a life-threatening physical condition caused or aggravated by pregnancy that places the woman in danger of death or a serious risk of substantial impairment of a major bodily function.. Since Sept. 1, abortion has been illegal in Texas after six weeks gestation, with one exception: If a doctor determines that a patient will face a " medical emergency " if the pregnancy continues, they can perform an abortion later on without breaking the law. Greg Abbott last year, not only bans abortion after six weeks of pregnancy but also deputizes citizens to enforce it, allowing any person to bring a . I'm so sorry,'" Elizabeth says. James and Elizabeth cried out their thanks to the doctor. "It is a pro-life position to allow physicians to make those life-and-death decisions," Seago said. The ethics panel had reached a decision, the doctor told them. But things can be murkier when it comes to treating miscarriages, she said. Either way, she saw nothing ahead but fear and grief prolonged, delayed, amplified. Financial supporters play no role in the Tribune's journalism. "And if they didn't believe me, I was going to show it to them and say "Look! So when Roe v . Question women in America now have to ask. For the women, expectant management after premature rupture of membranes comes with its own health risks. Or you wait till your baby's heartbeat stops.'". Julia Robinson for NPR Treatments for miscarriages and ectopic pregnancies are still legal under the states abortion ban, according to state law and legal experts. Hall shelled out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. In the medical profession, doctors will continue to grapple with the new legal restrictions, and the resultant dilemmas in obstetrical care, says Dr. Peaceman. Eventually, she found a clinic near Seattle that provides specialty care for patients who have decided to terminate due to lethal fetal abnormalities. Everyone was so scared.. But it is also affecting women who have no desire for termination but are experiencing medically risky pregnancies. "I was born with a physical disability. The emotional toll was what worried Hall most of all. (Texas Hospital Licensing Law); (3) an institution required to be licensed under . The case spurred a movement that led to the overturning of Ireland's abortion ban in 2018. "And if you leave it up to individuals, you're going to get uncertainty and people unwilling to make decisions. 245.002. And a tubal ectopic pregnancy, let's say, is clearly excluded. You're trying to understand exactly what's going on. But the most confusing development involves the exemptions that exist for the woman's life or health, or because of a "medical emergency." Another pending ban, a so-called "trigger law" passed by Texas in 2021, is expected to go into effect within weeks. There are currently no abortion laws that outlaw treatment of ectopic pregnancy. Elizabeth and James look at clothes that were meant for their baby, whom they lost in the second trimester of pregnancy. Very young rape victims tend to seek prenatal care late, and they are more likely to have small babies that score poorly on tests of heart rate and muscle tone given immediately after birth. Crescenda Uhles, a genetic counselor in Dallas, said the Texas law puts people like her in a bind when advising patients. July 20, 20225 PM Central. It just didnt occur to them that a ban would include cases like this.. An ectopic pregnancy, which occurs when a fertilized egg . A doctor hugs a patient at an abortion clinic in Santa Teresa, New Mexico, on 13 January 2023. Elizabeth touches the urn of her daughter. Her mental health spiraled to the point that she considered checking herself into the hospital. Abortion is permitted in Texas after six weeks only when a woman is facing a life-threatening or disabling medical emergency linked to her pregnancy. So we look at them like a ticking time bomb and wait for the complications to develop.. Ectopic pregnancy develops in an estimated 2% of reported pregnancies. Sign up for The Brief, our daily newsletter that keeps readers up to speed on the most essential Texas news. When they learned they were having a girl, Hall and her husband even picked out a name: Amelia. Texas new measure was intended to impose stringent limits on abortion. In fact, no abortion law in any state in America prevents lifesaving treatment for women with ectopic pregnancies and other life-threatening conditions . Pregnancy is dangerous, and there are many potential risks for a fatalityectopic pregnancy, severe preeclampsia, cancer, heart conditionsall things that would drive a person to seek an abortion. Hall and her husband left the specialists office in a daze. And that 'you can either stay here and wait to get sick where we can monitor you, or we discharge you and you monitor yourself. Now she wants those sentiments translated into action. There have been no criminal charges against providers since the U.S. Supreme Courts decision in late June to overturn the constitutional right to abortion access that was protected by Roe v. Wade, but anti-abortion groups and state lawmakers have threatened to ramp up the pressure against abortion providers and their allies. Time is of the essence. Recently passed laws make abortion illegal after about six weeks into a pregnancy. In other cases, a pregnant womans medical needs may conflict with those of her fetus. She wished she could make them answer for the states near-total ban on abortions after the overturning of Roe v. Wade just a few weeks prior. As a subscriber, you have 10 gift articles to give each month. Even with the slim chance of survival to 24 weeks, the newborn would face intense physical challenges and aggressive medical interventions. There has been apprehension by doctors about dealing with both of those two issues, Abbott told Fox 4 News. Disclosure: Southern Methodist University, Texas Medical Association and New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. The other option is called expectant management, in which Elizabeth would stay in the hospital and try to stay pregnant until 24 weeks, which is considered the beginning of "viability" outside the womb. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks. There they found themselves pinned down, clinically and emotionally, victims of a collision between standard obstetrical practice and the rigid new demands of Texas law. If I dont provide my patient the standard of care, which they are due, I could be sued.. It was like an evidence bag. She felt lost and confused. Elizabeth's pregnancy crisis began and ended weeks before June 24, when the U.S. Supreme Court struck down the federal right to abortion in its Dobbs v. Jackson ruling. Eventually, she laid out their options: Keep carrying the pregnancy or leave Texas to get an abortion. AUSTIN The Texas Medical Association wants regulators to step in after hospitals reportedly refused to treat patients with serious pregnancy complications for fear . The law does not make an exception for pregnant women who learn that the fetus has chromosomal abnormalities or anomalies that will cause the baby to die soon after birth. When you join us at The Texas Tribune Festival Sept. 22-24 in downtown Austin, youll hear from changemakers who are driving innovation, lawmakers who are taking charge with new policies, industry leaders who are pushing Texas forward and so many others. These provisions are in Chapter 170A of the Texas Health & Safety Code, which was enacted by House Bill 1280 in 2021. Julia Robinson for NPR Dr. Lauren Thaxton, an OB-GYN and assistant professor at the Dell Medical School at the University of Texas-Austin, has already heard about local patients who have been miscarrying, and couldn't get a pharmacy to fill their misoprostol prescription. "We skipped over the genetic testing offered in the first trimester," Elizabeth says. As Friday dragged on, Elizabeth started wondering if maybe the heartbeat had stopped. Hall was in her second trimester when the U.S. Supreme Court overturned Roe v. Wade, ending the constitutional protection for abortion and allowing states to set their own laws governing abortion access. The law makes no exceptions for nonviable pregnancies in which the fetus has no chance of survival. Treatment of ectopic pregnancy is not prohibited by Texas' abortion laws. In this chapter: (1) "Abortion" means the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means . Confusion around the laws has caused issues for patients outside of emergencies. These dismissals only increase the sense of isolation, stigma and shame. This article originally appeared on Austin American-Statesman: Here's what current Texas abortion laws say, plus birth control info not include an abortion that uses suction to dismember the body of an unborn child by sucking pieces of the unborn child into a . "I just cried and screamed in the parking lot," she recalls. But there was a vibe immediately. Most of these pregnancies end in miscarriage or stillbirth. As the Supreme Court appears poised to return abortion regulation to the states, recent experience in Texas illustrates that medical care for miscarriages and dangerous ectopic pregnancies would also be threatened if restrictions become more widespread. It is a horrible gamble that we are making Texas women go through.". If I offer the patient the standard of care, I could be sued for aiding and abetting, he said. But the Wellers and 28 million other Texans had already been living under a de facto abortion ban for 8 months, since September 2021. Almost immediately, though, Texas conflicting and confusing laws on abortion started to cause problems for pregnancy care. And for a few tense . She was through with being dismissed, being told to wait. "It might even be scary for you to reach out and seek support even mental health support. Doctors and experts also worry that patients with pregnancy complications may be too afraid of being accused of inducing an abortion to seek care. You cant even mention what someones choices would be, because of fear that talking about options would be considered aiding and abetting someone getting an abortion, he said. Even in cases of rape or incest, we dont advocate for taking the life of an unborn child for the crime of the father, he said. "'I'm just using this because this is not a viable pregnancy.'". The hospital where she works pays me to have these conversations with patients, but theres not necessarily any guarantee they would have my back should someone decide to list my name on a lawsuit, she said. Many Texans facing this same set of circumstances wont have the means to leave the state, Thoppil said, contributing to the states high rates of maternal morbidity and mortality, particularly among communities of color. Later in pregnancy, doctors can try to delay delivery to give the fetus more time to develop, while also warding off infection or other maternal complications such as hemorrhage. Photograph: Esteban Flix/AP And now the Texas abortion law has created an additional bind, Cavazos explains. All you can do now is just hope and pray that things go well.". Even if the mothers life is saved, Dr. Moayedi added, she could require an emergency hysterectomy, or removal of the uterus, which would leave her infertile. They now had some of the symptoms they needed to show the infection was getting worse. A doctor sat down and told her: "There's very little amniotic fluid left. First she said, I cant, I want this baby so badly, Dr. Gunby recalled. Texas abortion laws penalize the person who performs an abortion and, under a state law from 1925, anyone who furnishes the means for an abortion. Elizabeth's experience amounts to a kind of medical trauma, which is layered on top of the grief of pregnancy loss, says Elaine Cavazos, a psychotherapist specializing in the perinatal period, and the chief clinical officer of Reproductive Psychiatry and Counseling in Austin. Rather than warmth and sympathy, she was met with fear, hesitation and, worst of all, silence. Anencephalic babies born alive will likely survive only for hours or days; they will be unconscious, blind, deaf and will not voluntarily respond to touch or sound, according to the Cleveland Clinic. Back at home, the Wellers got more serious about their travel plans and started booking tickets. We havent seen a large issue, but there are certainly anecdotes, Thoppil said. But he did not address the question of lethal fetal anomalies, which are fatal for the fetus during pregnancy or shortly after birth. But those numbers have skyrocketed since Roe v. Wade was overturned. She had to go two days in a row and both times the staff gave her the support, sympathy and care shed been missing in Texas. Methotrexate also is listed in the Texas law passed last year. I have a code of ethics to uphold, and that is making sure I discuss with my patients all of their options, regardless of what is available in their area, Ms. Uhles said. Thats why Crawford said its important for patients to quickly seek medical care if they notice their pregnancy isnt progressing normally or they are bleeding. Unnamed, unknown doctors somewhere had come to an agreement that Elizabeth could be induced that night. Texas Health and Safety Code, Chapter 245. And they're telling me to think of the positives. Nitashia Johnson for The New York Times. But the incentives are all very strong for those providers to err on the side of not providing care.. But the National Advocates for Pregnant Women provide free legal assistance to women who have been charged with a crime because of a pregnancy loss like a miscarriage. I'm so sorry,'" Elizabeth says. ", Later on, Elizabeth said she realized that her anger at Methodist was misplaced. We never advocate taking a life of an unborn child unless it is necessary to protect the life of a woman, said Joe Pojman, executive director of the Texas Alliance for Life. She was admitted to the hospital, and later that night, when her own obstetrician called, she begged her for information. Most recently, the Oklahoma Senate passed six abortion-limiting bills , including one that would ban abortions after 30 days from a woman's last . Sometimes theyre the primary caregiver. And quickly. How do they follow the latest guidelines when numerous other people from other medical professionals to friends and family members can question their intent: Are they helping care for a miscarriage or facilitating an abortion? ", Her waters had broken, launching her into what she calls a "dystopian nightmare" of "physical, emotional and mental anguish." In retrospect, Elizabeth says their initial joy felt a little naive: "If it was so easy for us to get pregnant, then to us it was almost like a sign that this pregnancy was going to be easy for us.". She was diagnosed with an aggressive lymphoma, a cancer of the immune system. Correction, Oct. 24, 2022 at 4:12 p.m.: One Texas law passed last year lists several medications as abortion-inducing drugs and largely bars their use for abortion after the seventh week of pregnancy. Whether terminating an ectopic pregnancy is legal will depend on individual state laws. She took a swipe of the new discharge, and placed the toilet paper in a Ziploc bag to carry with her. Elizabeth was 18 weeks pregnant. In Texas, the second-largest state in the nation, legal abortion immediately ceased to be an option except to save the life of the pregnant patient. Right away, she ran into obstacles because of the Texas law. Health & Safety Code 245.002(1)(A)-(C). Or, like Hall, they can shell out thousands of dollars to abruptly travel out of state while grieving a lost pregnancy. Ilana Panich-Linsman for The New York Times. 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